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APEX > Unit 6 - Breathing Circuits > Flashcards

Unit 6 - Breathing Circuits Flashcards

1
Q

examples of open circuits

A
  • insufflation
  • simple face mask
  • nasal cannula
  • open drop
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2
Q

examples of semi-open circuits

A
  • Mapleson
  • circle system (FGF > Vm)
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3
Q

examples of semi-closed circuits

A

circle system (FGF < Vm)

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4
Q

example of closed circuit

A

circle system with very low FGF, APL closed

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5
Q

Benefits of low FGF in circle system

A
  • Increased humidity
  • Slower ↓ in temp
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6
Q

primarily influences rebreathing

A
  • FGF
  • Arrangement of components in circle system
  • Functioning unidirectional valves
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7
Q

3 different configurations possible with circle system and what determines which one it is

A
  1. semi-open
  2. semi-closed
  3. closed

depends on FGF and APL

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8
Q

purpose of unidirectional valves

A

ensure that gas only travels in one direction

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9
Q

example of how a circle system can be semi-open

A

using 10 L/min flow during induction

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10
Q

example of how a circle system can be a semi-closed system

A

reducing FGF to 2 L/min after intubation

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11
Q

example of how a circle system can be closed

A

FGF just enough to support gas consumption

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12
Q

Advantages of circle system

A
  • Consistent inspired gas concentrations
  • Maintains heat and humidity
  • Low resistance (not as low as Mapleson)
  • Can be semi-open, semi-closed, or closed
  • Minimizes OR pollution
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13
Q

disadvantages of circle system

A
  • Multiple places for disconnect to occur
  • Less portable than non-rebreathing
  • Unidirectional valves can malfunction
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14
Q

adverse effects of malfunctioning unidirectional valves

A
  • Stuck open: rebreathing
  • Stuck closed: airway obstruction
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15
Q

purpose of reservoir bag in circle system

A
  • protects patient against excessive airway pressure during SV
  • Allows you to generate positive pressure to deliver assisted or controlled ventilation
  • permits rebreathing and use of lower FGF
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16
Q

most distensible component of breathing system

A

Reservoir Bag

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17
Q

ASTM (American Society for Testing and Materials) requires that pressure inside adult-sized reservoir bag does not exceed internal pressure of ____ cm H2O if bag inflated up to ____ its size

A

60
4x

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18
Q

determines how much pressure can be generated inside circuit in bag mode

A

APL valve

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19
Q

acts like a stopcock that diverts gas flow to APL and bag or ventilator

A

Bag-Vent Selector Switch

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20
Q

where does dead space begin & end when unidirectional valves work properly

A

begins at Y piece
ends in terminal bronchioles

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21
Q

position of unidirectional valves during breathing cycle

A
  • Inspiratory valve is open during inspiration and closed during expiration
  • Expiratory valve is closed during inspiration and open during expiration
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22
Q

2 causes of increased inspired CO2

A
  1. Incompetent unidirectional valve
  2. CO2 absorbent exhaustion
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23
Q

what should be done in the event of an incompetent valve that can’t be fixed

A

a closed or semi-closed system should be converted to semi-open

24
Q

2 options if absorbent is exhausted during procedure

A

1) convert closed or semi-closed to semi-open by increasing FGF to 5-8 L/min
2) Change absorbent

25
Q

how does increasing Vm affect increased inspired CO2 d/t absorbent exhaustion

A

will NOT prevent CO2 rebreathing - must increase FGF

26
Q

which Mapelson is best and worst for spontaneous ventilation

A

best = Mapelson A
worst = B

27
Q

fresh gas inlet & APL location in Mapelson A

A
  • fresh gas inlet = near bag
  • APL = near patient
28
Q

fresh gas inlet & APL location in Mapelson B

A

inlet = near patient
APL = near patient

29
Q

fresh gas inlet & APL location in Mapelson C

A

inlet = near patient
APL = near patient

30
Q

fresh gas inlet & APL location in Mapelson D

A

inlet = near patient
APL = away from patient

31
Q

fresh gas inlet & APL location in Mapelson E

A

inlet = near patient
APL = away from patient

32
Q

fresh gas inlet & APL location in Mapelson F

A

inlet = near patient
APL = not present

33
Q

which Mapelson circuit does not have a reservoir bag

A

E

34
Q

which mapelson circuit does not have corrugated tubing

A

C

35
Q

which mapelson doesn’t have APL or reservoir bag

A

E

36
Q

how is rebreathing minimized with a mapelson

A

higher FGF, smaller Vt, and longer expiratory time

37
Q

best method of determining FGF required to prevent rebreathing with Mapelson

A

EtCO2

38
Q

advantages of mapelson circuits

A
  • Less airway resistance (good for peds)
  • Convenient
  • Easily scavenged
  • Bain circuit prevents heat loss
39
Q

disadvantages of mapelson circuits

A
  • Increased apparatus dead space
  • Requires high FGF to prevent rebreathing
  • Loss of heat and humidity
  • Inefficient use of inhaled anesthetics
  • Risk of environmental pollution
  • Unrecognized kinking of fresh gas hose in Bain circuit
40
Q

best and worst mapelson for controlled ventilation

A
  • Best: Mapleson D (DFE > BC > A)
  • Worst: Mapleson A
41
Q

general rule for FGF in mapelson circuit
what’s the exception

A

FGF ~2.5 times patients Vm to prevent rebreathing

Exception: Mapleson A requires FGF ~20 L/min during CV

42
Q

other factors besides FGF that affect rebreathing in Mapelson

A
  • Vm
  • mode of ventilation
  • RR
  • Vt
  • inspiratory flor rate
  • I:E
  • volume of reservoir bag
  • volume of corrugated tubing
  • use of mask/LMA/ETT
43
Q

what is the Bain system

A
  • Modified Mapleson D
  • FGF enters circuit through thin inner tubing, exhaled gas exits via corrugated tubing
44
Q

how is rebreathing prevented with Bain circuit

A

FGF should be 2.5x minute ventilation

45
Q

what test is performed as part of preanesthetic check out in Bain system

A
  1. Occlude elbow at patient end
  2. Close APL
  3. Use O2 flush to fill circuit
  4. Remove occlusion at elbow while flushing circuit
46
Q

results of Pethick test that mean Bain system is safe to use

A

Venturi effect will cause reservoir bag to collapse (circuit is safe to use)

47
Q

results of Pethick test that mean Bain system is not safe to use

A

If inner tubing is occluded, reservoir bag will remain inflated

48
Q

what type of breathing circuit does not contain dead space

A

open

all other circuits are closed to atmosphere and contain some degree of d

48
Q

what type of breathing circuit does not contain dead space

A

open

all other circuits are closed to atmosphere and contain some degree of d

49
Q

which 3 mapelson circuits are most likely to be encountered in modern anesthesia practice

A

D, E, F

50
Q

what type of breathing circuit are Mapelsons

A

all are semi-open or non-rebreathing

51
Q

what type of circuit contains a reservoir bag but does not allow rebreathing of exhaled gases

A

semiopen

52
Q

what type of circuit contains a reservoir bag but does not allow rebreathing of exhaled gases

A

semi-open

53
Q

what’s different about a Bain circuit vs. Mapelson D

A

fresh gas travels towards the patient through a smaller tube inside the corrugated tubing

54
Q

how is incoming fresh gas warmed by Bain system

A

by the exhaled gas

APEX (54 decks)

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